Unreversed prism gonioscopy lens assembly

ABSTRACT

In one embodiment of the present disclosure, a double-reflecting contact lens assembly for viewing the anterior chamber of an eye is provided. The lens assembly includes: (a) a lens body having a contact end defining at least a portion of first surface and a viewing end defining at least a portion of a second surface, wherein the lens body is a prism having an optical axis and magnification in the range of greater than 1× to about 2×; (b) a first reflecting surface disposed adjacent the lens body; and (c) a second reflecting surface disposed adjacent the lens body opposing the first reflecting surface. Other embodiments of the present disclosure include methods of making the lens assembly, methods of use, and a lens and handle assembly.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No.62/012,189, filed Jun. 13, 2014, and U.S. Provisional Application No.61/987,678, filed May 2, 2014, the disclosures of which are herebyexpressly incorporated by reference herein in their entireties.

BACKGROUND

In some ophthalmic procedures, it is desirable to view the periphery ofthe anterior chamber when the doctor's line of sight is along theoptical axis of the eye. Having a line of sight along the optical axisof the eye is not possible with previously designed lenses. Therefore,there exists a need for a lens assembly enabling such a view for variousophthalmic procedures.

SUMMARY

This summary is provided to introduce a selection of concepts in asimplified form that are further described below in the DetailedDescription. This summary is not intended to identify key features ofthe claimed subject matter, nor is this summary intended to be used asan aid in determining the scope of the claimed subject matter.

The present disclosure relates generally to instruments of the typebroadly applicable to ophthalmic procedures. As will be described inmore detail below, the one or more examples of instruments includes acontact lens configured for direct contact for viewing parts of an eye.

In accordance with one embodiment of the present disclosure, adouble-reflecting contact lens assembly for viewing the anterior chamberof an eye is provided. The lens assembly includes: (a) a lens bodyhaving a contact end defining at least a portion of first surface and aviewing end defining at least a portion of a second surface, wherein thelens body is a prism having an optical axis and magnification in therange of greater than 1× to about 2×; (b) a first reflecting surfacedisposed adjacent the lens body; and (c) a second reflecting surfacedisposed adjacent the lens body opposing the first reflecting surface.

In accordance with another embodiment of the present disclosure, adouble-reflecting contact lens assembly for viewing the anterior chamberof an eye is provided. The lens assembly includes: (a) a lens bodyhaving a contact end defining at least a portion of an eye contactsurface and a viewing end defining at least a portion of a viewingsurface, wherein the lens body is a prism having an optical axis andmagnification in the range of greater than 1× to about 1.5×; (b) a firstreflecting surface disposed adjacent the lens body, wherein the firstreflecting surface is substantially planar and intersects the viewingend of the lens body; (c) a second reflecting surface disposed adjacentthe lens body opposing the first reflecting surface, wherein the secondreflecting surface is substantially planar and intersects the contactand viewing ends of the lens body; (d) a first outer portion adjacentthe first reflecting surface having a contact end defining at least aportion of the eye contact surface and a viewing end defining at least aportion of the viewing surface; and (e) a second outer portion adjacentthe second reflecting surface having a contact end defining at least aportion of the eye contact surface and a viewing end defining at least aportion of the viewing surface, wherein the lens body and the first andsecond outer portions define a lens assembly having a substantiallycircular cross-section though a plane perpendicular to the optical axis.

In accordance with another embodiment of the present disclosure, amethod of making a lens assembly is provided. The method includes: (a)obtaining a lens body having a contact end defining at least a portionof an eye contact surface and a viewing end defining at least a portionof a viewing surface, wherein the lens body is a prism having an opticalaxis, a first planar surface and a second planar surface, andmagnification in the range of greater than 1× to about 1.5×; (b)attaching first and second reflecting surfaces to the first and secondplanar surfaces of the lens body in an opposing relationship to oneanother; (c) attaching a first outer portion to the first reflectivesurface; (d) attaching a second outer portion to the second reflectivesurface; and (e) grinding and polishing the lens assembly to have asubstantially circular cross-section through a plane perpendicular tothe optical axis.

In accordance with another embodiment of the present disclosure, amethod of using a lens assembly to view an anterior chamber of an eye isprovided. The method includes: (a) obtaining a lens body having acontact end defining at least a portion of an eye contact surface and aviewing end defining at least a portion of a viewing surface, whereinthe lens body is a prism having an optical axis, a first planar surfaceand a second planar surface, and magnification in the range of greaterthan 1× to about 1.5×; and (b) viewing a first portion of the anteriorchamber of the eye from a view substantially parallel to the opticalaxis of the eye.

In accordance with another embodiment of the present disclosure, adouble-reflecting contact lens and handle assembly for viewing theanterior chamber of an eye is provided. The lens and handle assemblyincludes (a) a lens including a lens body having a contact end definingat least a portion of first surface and a viewing end defining at leasta portion of a second surface, wherein the lens body is a prism havingan optical axis and magnification in the range of greater than 1× toabout 2×, a first reflecting surface disposed adjacent the lens body,and a second reflecting surface disposed adjacent the lens body opposingthe first reflecting surface; and (b) a handle for carrying the lens inin a manner that provides rotation thereof, the handle including anactuator carried by the handle, wherein the actuator is configured toaffect rotation of the lens.

In any of the embodiments described herein, the at least a portion ofthe first surface may be contoured to conform to the surface of an eye.

In any of the embodiments described herein, the first surface may have acontact diameter of less than 11 mm.

In any of the embodiments described herein, the first surface may have acontact diameter of less than 10 mm.

In any of the embodiments described herein, the viewing end may beangled relative to the optical axis.

In any of the embodiments described herein, the magnification of thelens body may be in the range of about 1.0× to about 2.0×, about 1.1× toabout 1.5×, or about 1.2× to about 1.3×

In any of the embodiments described herein, the first reflecting surfaceis angled relative to the optical axis, the angle being in the range ofabout 22 degrees to about 38 degrees.

In any of the embodiments described herein, the second reflectingsurface may be angled relative to the optical axis, the angle being inthe range of +/−10 degrees.

In any of the embodiments described herein, the first reflecting surfacemay intersect the contact and viewing ends of the lens body.

In any of the embodiments described herein, the first reflecting surfacemay intersect only the viewing end of the lens body.

In any of the embodiments described herein, the second reflectingsurface may intersect the contact and viewing ends of the lens body.

In any of the embodiments described herein, the first reflecting surfacemay be substantially planar.

In any of the embodiments described herein, the second reflectingsurface may be substantially planar.

In any of the embodiments described herein, the lens assembly mayfurther include a first outer portion adjacent the first reflectingsurface having a contact end defining at least a portion of the firstsurface and a viewing end defining at least a portion of the secondsurface.

In any of the embodiments described herein, the lens assembly mayfurther include a first outer portion adjacent the first reflectingsurface having a viewing end defining at least a portion of the secondsurface.

In any of the embodiments described herein, the lens assembly mayfurther include a second outer portion adjacent the second reflectingsurface having a contact end defining at least a portion of the firstsurface and a viewing end defining at least a portion of the secondsurface.

In any of the embodiments described herein, the lens body and the firstand second outer portions define a lens assembly which may have asubstantially circular cross-section though a plane perpendicular to theoptical axis.

In any of the embodiments described herein, the lens assembly mayfurther include a beveled edge at the first surface.

In any of the embodiments described herein, the lens assembly mayfurther include a cut-out portion in the first surface.

In any of the embodiments described herein, the lens assembly does notinclude an outer protective coating.

In any of the embodiments described herein, the method of use mayfurther include performing surgery on the first portion of the anteriorchamber of the eye.

In any of the embodiments described herein, the method of use mayfurther include rotating the lens assembly to view a second portion ofthe anterior chamber of the eye.

In any of the embodiments described herein, rotation may be achieved bya rotating handle assembly.

In any of the embodiments described herein, the method of use mayfurther include rotation may be achieved by one-handed actuation of thehandle assembly.

In any of the embodiments described herein, the method of use mayfurther include performing surgery on the second portion of the anteriorchamber of the eye.

In any of the embodiments described herein, the lens may be surroundedby a collar, the collar defining a ring gear.

In any of the embodiments described herein, the actuator may include adrive shaft having a drive gear disposed on the distal end thereof, thedrive gear configured and arranged to mesh with the ring gear.

In any of the embodiments described herein, the actuator may be manuallyactuated.

In any of the embodiments described herein, the actuator may be actuatedvia a drive motor.

In any of the embodiments described herein, the drive motor may bemounted to the handle and may interface with the drive shaft.

In any of the embodiments described herein, the handle may include ahandle portion and a lens retainer portion.

DESCRIPTION OF THE DRAWINGS

The foregoing aspects and many of the attendant advantages of thisdisclosure will become more readily appreciated by reference to thefollowing detailed description, when taken in conjunction with theaccompanying drawings, wherein:

FIG. 1 is a side cross-sectional view of a contact lens assembly incontact with an eye in accordance with one embodiment of the presentdisclosure;

FIG. 2 is a top isometric view of the contact lens assembly of FIG. 1;

FIG. 3 is a bottom isometric view of the contact lens assembly of FIG.1;

FIGS. 4-6 are various side views of the contact lens assembly of FIG. 1;

FIG. 7 is an exploded view of the contact lens assembly of FIG. 1.

FIG. 8 is a side cross-sectional view of a contact lens assembly incontact with an eye in accordance with another embodiment of the presentdisclosure;

FIG. 9 is a top isometric view of the contact lens assembly of FIG. 8;

FIG. 10 is a bottom isometric view of the contact lens assembly of FIG.8;

FIGS. 11-13 are various side views of the contact lens assembly of FIG.8;

FIG. 14 is an exploded view of the contact lens assembly of FIG. 8;

FIG. 15 is a side cross-sectional view of a previously designedSwan-Jacob Gonioprism contact lens;

FIG. 16 is a side cross-sectional view of a previously designed Ahmed1.5× Surgical Gonio contact lens;

FIG. 17 is a side cross-sectional view of a previously designed Tanocontact lens;

FIGS. 18A and 18B are comparative microscope views showing the field ofview with a previously designed Tano contact lens and a contact lensassembly in accordance with one embodiment of the present disclosure;

FIGS. 19 and 20 are views of a contact lens assembly in accordance withanother embodiment of the present disclosure, with the contact lensassembly including a beveled edge;

FIGS. 21-23 are views of a contact lens assembly in accordance withanother embodiment of the present disclosure, with the contact lensassembly having a wider field of view as compared to the embodimentshown in FIG. 8; and

FIGS. 24A-36 are views of embodiments of lens handles for rotationalcontrol of the lenses.

DETAILED DESCRIPTION

Embodiments of the present disclosure are generally directed to contactlenses for use in ophthalmic procedures. Referring to FIGS. 1-7, acontact lens assembly 20 in accordance with one embodiment of thepresent disclosure is a lens designed for direct contact with the corneaC of an eye E (see FIG. 1). The lens assembly 20 is unreversed prismgonioscopy lens assembly designed to view the periphery of the anteriorchamber angle A of the eye E. In that regard, the lens assembly 20 ofthe illustrated embodiment is a two-mirrored lens for an unreversedview.

Common lenses for use in gonioscopy (i.e., viewing the anterior chamberangle of the eye) are known as meniscus gonioscopy lenses, such as thecommercially available Swan-Jacob Gonioprism Lens (the “Swan lens”) byOcular Instruments, Inc. (see FIG. 15). The Swan lens is a contact lenshaving a contact surface that conforms to the surface of an eye. Thecontact surface is curved and has an optical axis that may be alignedwith the optical axis of the eye. The Swan lens also has a viewingsurface that is offset in an anterior direction from the contact surfaceand has an optical axis that intersects the optical axis of the contactsurface. When the Swan lens is positioned on the eye, the user may viewthe anterior chamber angle of the eye by looking into the Swan lensalong an axis that crosses the contact surface optical axis.

Embodiments of the present disclosure are directed to unreversed prismgonioscopy lens assemblies that allow for visualization of the anteriorchamber angle A of the eye. The visualization is substantially normal tothe surgical field, but not normal to an anterior curve that is offsetat an angle relative to the patient's eye, as in typical Swan lenses. Inthat regard, the direction of observation, which may be through amicroscope, is substantially parallel to the optical axis 40 of thepatient's eye E. In accordance with embodiments of the presentdisclosure, substantially normal to the surgical field may include arange of up to + or −10 degrees from normal.

One advantage of such a normal viewing angle is that the doctor mayremain in one position without adjusting a microscope if using one,while simply rotating the lens to view the entire 360 degrees of theanterior chamber of the patient's eye. For 360 degree rotation withoutadjusting the position of the lens assembly 20, the optical path P1 forviewing the anterior chamber angle A of the patient's eye E must bewithin a distance D from the optical axis 40 of the patient's eye E,wherein the distance D is less than one half of the greatest distance Lacross the anterior chamber (see FIG. 1).

An exemplary two-mirror unreversed lens assembly, although moredifficult to build than a single-mirror lens assembly, allows the userto see the patient's eye in an unreversed view, as opposed to a reversed“mirror image” view seen by a single-mirror lens assembly. An exemplarysingle mirror lens assembly is the commercially available Ahmed 1.5×Surgical Gonio, by Ocular Instruments, Inc. (see FIG. 16). The singlemirror in the Ahmed lens provides visualization substantially normal tothe surgical field, but the user sees the patient's eye in a reversedview. In contrast to a single-mirror view, a two-mirror unreversed viewis particularly helpful when performing surgery because the tactilemovements of the instruments match what is seen in the unreversed image.

Referring to FIGS. 1-7, lens assembly 20 includes a lens body 22 havinga contact end 24 defining at least a portion of a first surface or aneye contact surface 26 and a viewing end 28 defining at least a portionof a second surface or a viewing surface 30. The lens body 22 is a prismdefining the viewing lens through which the user peers at the patient'seye E. The lens body 22 may be manufactured from glass, acrylic, or anyother material having suitable optics and capable of being cleanedand/or sterilized.

The eye contact surface 26 is designed and configured for contact withthe cornea region C of an eye E. Therefore, the eye contact surface 26is concave in shape and conforms to and is compatible with the convexanterior surface of an eye E. In the illustrated embodiment, the radiusof curvature of the eye contact surface 26 is about 7.85 mm; however,other radii of curvatures designed to approximate the curvature of anaverage human eye (or animal eye in veterinary applications) are withinthe scope of the present disclosure. For example, the radius ofcurvature of the eye contact surface 26 may be in the range of about 6.5mm to about 9 mm.

In one embodiment of the present disclosure, the lens assembly 20 may besized to have a contact surface 26 diameter in the range of less thanabout 10 mm. In that regard, the lens assembly 20 is compatible with theaverage cornea, wherein the circular region where the cornea C meet thesclera S has a diameter of about 12 mm. In one embodiment of the presentdisclosure, the contact surface 26 diameter may be about 9.75 mm.Optical axis 40 extends through the eye contact surface 26. The contactsurface allows for a clear corneal incision, for example at a point ofincision I in FIG. 1 such that a surgical tool (not shown) can be usedin the anterior chamber angle A opposite the point of incision I.

The viewing surface 30 may be a curved surface and its optical axis mayintersect the eye's optical axis 40. In the illustrated embodiment, theradius of curvature of the viewing surface 30 is about 20 mm; however,other viewing surface 30 curvatures are within the scope of the presentdisclosure. The viewing surface 30 curvature can provide imagemagnification through the lens body 22. Laterally shifting and/ortilting the viewing surface 30 can enhance the image quality.

The use of prism (reflecting) surfaces 50 and 52 in the lens assembly 20allows for viewing the anterior chamber angle A while allowing the userto view from a view angle substantially parallel to the optical axis 40of the eye E (as opposed to a more tilted view angle). As mentionedabove, such a view angle may be along the optical axis 40, substantiallyparallel to the optical axis 40, or within an angle range of up to + or−10 degrees of parallel to the optical axis 40. Such a view angleprovides the advantage of allowing the user to view multiple areasaround the anterior chamber angle A the eye E without needing to adjusthis or her body and/or the angle of the microscope relative to thepatient.

As mentioned above, the lens assembly 20 of the illustrated embodimentis an unreversed prism gonioscopy contact lens assembly. In that regard,the lens assembly 20 includes a first reflecting surface 50 disposedadjacent the lens body 22. In the illustrated embodiment, the firstreflecting surface 50 is substantially planar and intersects the contactand viewing ends 24 and 28 of the lens body 22. The lens assembly 20further includes a second reflecting surface 52 disposed adjacent thelens body 22 opposing the first reflecting surface 50, wherein thesecond reflecting surface 52 is substantially planar and intersects thecontact and viewing ends 24 and 28 of the lens body 22.

The reflecting surfaces 50 and 52 may be total internal reflecting (TIR)surfaces or coated with appropriated surfaces to provide mirroredsurfaces. In some embodiments, reflecting surface 50 may be a TIRsurface next to air. In some embodiments, reflecting surface 52 may be amirrored surface due to the typical angle of incidence.

In the illustrated embodiment, the first and second reflecting surfaces50 and 52 are substantially planar. However, non-planar surfaces arealso within the scope of the present disclosure. In that regard, thesurfaces 50 and 52 may be designed with some curvature to correct theimage or add magnification to the view. Although non-planar surfaces mayadd magnification, they also may distort the image.

In the illustrated embodiment, the first reflecting surface 50 ispositioned at an angle of about 30 degrees relative to the optical axis40 and intersects the optical axis 40 near the eye contact surface 26.In some embodiments of the present disclosure, the first reflectingsurface 50 may be positioned at an angle in the range of about 22 toabout 38 degrees relative to the optical axis 40, or in the range ofabout 25 to about 35 degrees relative to the optical axis 40.

The second reflecting surface 52 is positioned substantially parallel tothe optical axis 40. In some embodiments of the present disclosure, thesecond reflecting surface 52 may be positioned at an angle in the rangeof about 85 to about 95 degrees+/−5 degrees relative to the optical axis40. In this configuration, the viewer views the anterior chamber angle Aof the eye E along path P1. Likewise, the viewer may also view theanterior chamber angle A of the eye E from a slightly tilted view alongone of paths P2 or P3.

As seen in the illustrated embodiment of FIGS. 1-7, the lens assembly 20may have a circular cross-section through a plane perpendicular to theoptical axis 40. To make a circular cross-section, the lens assembly 20may include optional first and second outer portions 70 and 80, such asglass filler portions, as can be seen in exploded view in FIG. 7. Inother embodiments of the present disclosure, either of first and secondouter portions 70 and 80 or both may not be included in the lensassembly 20.

The first outer portion 70 is attached to the first reflecting surface50 on the opposite side of the first reflecting surface 50. The firstouter portion 70 may include a contact end 72 defining at least aportion of the eye contact surface 26 and viewing end 74 defining atleast a portion of the viewing surface 30. First outer portion 70 is notneeded optically, but is designed to protect first reflecting surface 50and to provide a lens assembly 20 having a circular cross-sectionthrough a plane perpendicular to the optical axis 40.

The second outer portion 80 is attached to the second reflecting surface52 on the opposite side of the second reflecting surface 52. The secondouter portion 80 may include a contact end 82 defining at least aportion of the eye contact surface 26 and viewing end 84 defining atleast a portion of the viewing surface 30. Second outer portion 80, likefirst outer portion 70, is not needed optically, but is designed toprotect second reflecting surface 52 and to provide a lens assembly 20having a circular cross-section through a plane perpendicular to theoptical axis 40.

In the illustrated embodiment, the first and second outer portions 70and 80 are shown as extending between and defining a portion of the eyecontact and viewing surfaces 26 and 30 of the lens assembly 20. However,in certain embodiments, the first and second outer portions 70 and 80need not extend completely from the eye contact surface 26 to theviewing surface 30 of the lens assembly 20. In that regard, theseportions 70 and 80 may extend a portion of the distance between the eyecontact surface 26 and the viewing surface 30 of the lens assembly 20.(See, for example, the alternate embodiment of FIGS. 8-14.)

Referring to FIGS. 19 and 20, in one embodiment of the presentdisclosure, the contact end 224 includes an optional beveled edge 290 atthe contact end 224 of the lens assembly 220. The beveled edge 290allows for reduced contact area of the lens assembly 220 with the eye E(as compared to the viewing cross-sectional area of the lens assembly)to enable the use of surgical instruments on the eye E in or near theouter circumference of the beveled edge 290. In that regard, there isreduced interference around the eye E for the user who may be performingsurgery on the eye E while using the contact lens assembly 220. In theillustrated embodiment, the bevel 90 is at a 45 degree angle relative tothe optical axis. However, other angles for the bevel 290 are alsowithin the scope of the present disclosure.

In addition to or in lieu of a bevel, exclusion of one or both of thefirst and second outer portions 70 and 80 (see FIG. 1) may also providereduced interference around the eye E for the user who may be performingsurgery on the eye E while using the contact lens assembly 20.

The lens body 22 is designed and configured to include magnification toaid in visualization of the anterior chamber angle A of the eye E.Magnification is typically provided by use of an external microscope.However, high magnification in an external microscope can decrease thefield of view seen by the microscope, limiting the view outside theophthalmic contact lens. For example, compare the field of view in FIG.18A for a previously designed lens designed for vitrectomy viewing andhaving no magnification and FIG. 18B for a lens assembly in accordancewith embodiments of the present disclosure including 1.3× magnification.

In FIG. 18A, a photograph of an eye is shown at a microscope setting of25× using the Tano Lens (the “Tano lens”) by Ocular Instruments, Inc.,commercially available in 1997. The Tano lenses, one example of which isseen in FIG. 17, were developed for viewing the vitrectomy region in theback of the eye and/or the anterior chamber angle, but were not designedfor surgical procedures in the anterior chamber angle A of the eye E.Referring to FIG. 17, the Tano lens is a double-mirror lens assemblyhaving no curvature on its viewing end. Therefore, the magnificationprovided by the Tano lens is less than 1×, at about 0.8×. The previouslydesigned Tano lens for viewing the anterior chamber angle did not haveenough magnification for surgery. Its primary use was for inspection ofthe anterior chamber angle during vitrectomy surgery. Therefore, thediameter of the Tano lens was designed to fit into common vitrectomeyrings that are sutured to the eye during surgery.

Because of limitations in manufacturing processes, reflective surfaces,and adhesives in the 1990s, the Tano lens was coated with an outerprotective coating P to prevent degradation of the lens particularly atthe seams. Such protective coatings did not impair light entry forviewing the vitrectomy region in the back of the eye. However, theinventors found such protective coatings to impair the surgical view ofthe anterior chamber angle. Therefore, embodiments of the presentdisclosure are manufactured with advanced manufacturing processes,reflective surfaces, and adhesives without requiring an outer protectivecoating.

Because of the reduced magnification in the Tano lens, highmagnification of 25× is used in the microscope to adequately view theanterior chamber angle A of the eye E for surgery in the trabecularmeshwork. The result of such high magnification in the microscope is alimited view of the surgical field, impairing the surgeon's ability tooperate, as can be seen in FIG. 18A.

Referring now to FIG. 18B, a photograph of an eye is shown at amicroscope setting of 16× using a lens assembly in accordance withembodiments of the present disclosure having 1.3× magnification in thelens assembly. With reduced microscope magnification of 16× (as comparedto 25× in FIG. 18A), the anterior chamber angle A of the eye E can beadequately viewed while still provided a large view of the surgicalfield.

In accordance with embodiments of the present disclosure, magnificationis provided in the lens body 22 itself to increase magnification of theeye E while maintaining the microscope field of view. Suitablemagnification may be in the range of greater than 1×, in the range ofabout greater than 1× to 2×, in the range of about 1.1× to about 1.5×,or in the range of about 1.2× to about 1.3×.

The illustrated embodiment of FIGS. 1-7 may be useful in glaucomaexamination and/or surgical procedures, for example, procedures fordisorders such as open-angle and/or closed-angle glaucoma. Generallydescribed, aqueous humor, a fluid that is produced within the eye,drains via the trabecular meshwork into the canal of Schlemm then intothe scleral plexuses and into general blood circulation of the body.

The major risk factor for most glaucoma's, and the focus of treatment,is relieving increased intraocular pressure, which is a function of theproduction of liquid aqueous humor without adequate drainage. Inopen/wide-angle glaucoma, flow is reduced through the trabecularmeshwork as a result of degeneration and/or obstruction of thetrabecular meshwork. To relieve the increased intraocular pressure, oneor more stents may be inserted into the trabecular meshwork in variouslocations.

For example, a stent for Micro Invasive Glaucoma Surgery (MIGS) has beenrecently approved by the FDA to improve fluid outflow in open-angleglaucoma patients for implantation in the patient's eye during cataractsurgery

In the cataract procedure, the microscope is generally positioned suchthat the doctor's line of sight is along the optical axis. Therefore, itis desirable to perform the anterior chamber angle procedures with themicroscope in the same position. Embodiments of the present disclosureenable a view the periphery of the anterior chamber when the doctor'sline of sight is along the optical axis.

Other procedures performed after a cataract surgery may include abinterno approaches include synechiolysis, goniotomy, placenent of aqueasdrainage stents etc. In ab interno approaches, the trabecular meshworkis engaged from inside the anterior chamber, having the benefits of onlyclear cornea healing with the sclera and conjunctiva left intact.

To insert such stents during an open-angle glaucoma surgical procedure,the user may move or rotate the lens assembly 20 to a first position onthe eye E to insert a first stent into the anterior chamber angle A ofthe eye E, then to a second position on the eye E to insert a secondstent into another place in the anterior chamber angle A of the eye E.Likewise, during an examination procedure, the user may move the lensassembly 20 from a first position on the eye E to examine a firstportion of the anterior chamber angle A, then to a second position onthe eye E to examine a second portion of the anterior chamber angle A.

Embodiments of the present disclosure may also be used in closed-angleglaucoma surgical procedures. In closed-angle glaucoma (or angle closureglaucoma), the iridocorneal angle may become closed because of forwarddisplacement of the iris against the cornea. Such displacement mayimpede aqueous fluid flow from the posterior chamber to the anteriorchamber of the eye and then out of the trabecular network. Thisaccumulation of aqueous humor causes an acute increase of pressure andpain.

To view areas of the eye where the anterior chamber angle is closed,embodiments of the present disclosure allow the user to rotate the lensto view multiple positions along the perimeter of the anterior chamberangle and, in some cases, the entire periphery of the anterior chamberangle.

In use, referring to FIG. 1, the lens assembly 20 is placed upon the eyeE of a patient. To view the anterior chamber angle A of the eye E usingthe contact lens assembly 20 of the present disclosure, the viewer viewsin a direction along or substantially parallel or slightly angledrelative to the optical axis 40 of the eye E, for example, alongexemplary viewing paths P1, P2, or P2.

If surgically operating on the eye, surgical instruments may be insertedat the junction between the cornea C and sclera S regions of the eye E.The small sizing of the lens assembly 20 and the beveled edge 90 at thecontact end 24 of the lens assembly 20 provide for areas for surgicalinstruments to be inserted into the eye E.

The user may need to view and/or surgically operate on multiple regionsaround the perimeter of the anterior chamber angle A of the eye.Therefore, the user may need to rotate the lens assembly 20 on theuser's eye. In one embodiment of the present disclosure, the user mayhold the lens assembly 20 by hand and rotate the lens assembly 20. Inanother embodiment of the present disclosure, the user may dispose thelens assembly 20 in a handle assembly 92, and rotate the handle torotate the lens assembly 20. In another embodiment of the presentdisclosure, the lens assembly 20 may be rotatable within a collarattached to the handle. Therefore, the user would hold the handle in oneposition with one hand and use the second handle to rotate the lensassembly 20 within the collar.

In another embodiment of the present disclosure, the handle assembly maybe configured for rotating the lens assembly 20 relative to the eye E.In one exemplary embodiment, the use can rotate the lens assembly 20 onthe eye E by using a one-handed operation. In that regard, the userholds the handle assembly holding the lens assembly 20 steady againstthe patient's eye E. Then, the user moves a user-manipulatable actuatorthat affects rotational movement of the lens assembly 20 with respect tothe handle assembly. An exemplary handle assembly designed forone-handed operation is described in greater detail below.

In other embodiments of the present disclosure, the lens handle may be adisposable or reusable lens handle. In some embodiments, the lens handlemay be permanently affixed to the lens assembly. In one embodiment, thelens handle and the lens assembly are permanently affixed to one anotherand made for one-time use.

A method of making the lens assembly will now be described in greaterdetail. First, the maker manufactures a lens body 22 in accordance withembodiments of the present disclosure. The lens body 22 has beendesigned to have a contact end 24 defining at least a portion of an eyecontact surface 26 of the lens assembly 20 and a viewing end 28 definingat least a portion of a viewing surface 30 of the lens assembly 20. Thelens body 22 is a prism having an optical axis 40, a first planarsurface 42 and a second planar surface 44, and magnification in therange of about 1.1× to about 1.5×.

The maker of the lens assembly 20 attaches first and second reflectingsurfaces 50 and 52 to the first and second planar surfaces 42 and 44 ofthe lens body 22 in an opposing relationship to one another. Suchreflecting surfaces may be plated on the lens body 22 using conventionalplating techniques.

The maker of the lens assembly 20 then attaches a first outer portion 70to the first reflective surface 50 and a second outer portion 80 to thesecond reflective surface 52. Such first and second outer portions 70and 80 may be attached using adhesives designed to withstand hightemperature sterilization techniques for reusable lens assemblies andwithout requiring a protective outer coating on the lens assembly 20.

The lens assembly 20 is then ground and polished to have desired ocularproperties and a substantially circular cross-section through a planeperpendicular to the optical axis 40.

Referring now to FIGS. 8-14, another embodiment of the presentdisclosure will be described. The lens assembly 120 of FIGS. 8-14 issubstantially similar to the lens assembly 20 of FIGS. 1-7, except fordifferences regarding the shape and dimensions of the lens assembly andthe contact surface and the configuration of the reflecting surfacesrelative to the lens body. Like elements in the lens 120 of FIGS. 8-14use like numerals as the lens assembly 20 in FIGS. 1-7, exceptenumerated in the 100 series.

The contact lens 120 shown in the illustrated embodiment of FIGS. 8-14,like the embodiment of FIGS. 1-7, may be useful in glaucoma examinationand/or surgical procedures. As described above, surgical tools may beinserted into the eye E at the junction between the cornea C and scleraS regions of the eye E.

In the illustrated lens assembly 120 of FIGS. 8-14, the viewing surface130 and the contact area of the eye contact surface 126 are larger thanthose surfaces of the previously described embodiment. In that regard,the lens body 122 is larger, providing a wider field of view, ascompared to the lens body 22 of the illustrated embodiment of FIGS. 1-7.The larger lens body 122 has the advantageous effect of not having to berotated as frequently for the user to view the portions or the entiretyof the perimeter of the anterior chamber angle A.

In one embodiment, the contact surface 126 diameter of the lens assembly120 is larger than the contact surface 26 diameter of the previouslydescribed embodiment of FIGS. 1-7. To enable use of a larger lens body122 having a larger contact surface 126 diameter, the lens assembly 120includes a cutout portion 134 in the contact end 124 to enable theinsertion of surgical instruments, as can be seen FIGS. 8, 10, 12, and14.

Like the previously described embodiment, the lens body 122 of FIGS.8-14 has two planar surfaces 142 and 144 (see FIG. 14) that areconfigured as reflecting surfaces 150 and 152 (see FIG. 8) to define anunreversed prism gonioscopy contact lens assembly 120. The firstreflecting surface 150 is disposed adjacent the lens body 122. In theillustrated embodiment, the first reflecting surface 150 issubstantially planar and intersects only the viewing end 128 of the lensbody 122. In that regard, the first reflecting surface 150 is truncatedat corner 154 and includes shelf 172. This truncated configuration forthe first reflecting surface 150 may help in reducing glare for the userof the lens assembly 120. This truncated configuration may also increasethe field of the anterior chamber angle A in the anterior direction andincrease the central view (straight down through the lens body 122without using a mirror) to show an instrument moving from the point ofincision I to the anterior chamber angle A.

The second reflecting surface 152 is disposed adjacent the lens body 122opposing the first reflecting surface 150. The second reflecting surface152 is substantially planar and extends between both the contact andviewing ends 124 and 128 of the lens body 122. The reflecting surfaces150 and 152 may suitably be mirrored or TIR surfaces, or otherreflecting surfaces.

In the illustrated embodiment, the first reflecting surface 150 ispositioned at an angle of about 30 degrees relative to the optical axis140 and intersects the optical axis 140 near the eye contact surface126. The second reflecting surface 152 is positioned substantiallyparallel to the optical axis 140. In this configuration, the viewerlooking in view path parallel to the optical axis 140 of the eye E,views the anterior chamber angle A of the eye E along path P3. Likewise,the viewer may also view the anterior chamber angle A of the eye E froma tilted view along path P4.

In use, referring to FIG. 8, the lens assembly 120 is placed upon theeye E of a patient against the eye. To view the periphery of theanterior chamber angle A of the eye E using the contact lens assembly120 of the present disclosure, the viewer views in a direction along orsubstantially parallel or slightly titled relative to the optical axis140 of the of the lens assembly 120, for example, along exemplaryviewing paths P4, P5, or P6.

If surgically operating on the eye, surgical instruments may be insertedat the junction between the cornea C and sclera S regions of the eye E.The cutout region 134 at the contact end 124 of the lens assembly 120provides an area for surgical instruments to be inserted into the eye E.

A method of making the lens assembly will now be described in greaterdetail. First, the maker manufactures a lens body 122 in accordance withembodiments of the present disclosure. The maker of the lens assembly120 attaches first and second reflecting surfaces 150 and 152 to thefirst and second planar surfaces 142 and 144 of the lens body 122 in anopposing relationship to one another. Such reflecting surfaces may beplated on the lens body 122 using plating techniques.

The maker of the lens assembly 120 then attaches a first outer portion170 to the first reflective surface 150 and a second outer portion 180to the second reflective surface 152. Such first and second outerportions 170 and 180 may be attached using adhesives designed towithstand high temperature cleaning techniques for lens assemblies andwithout requiring a protective outer coating on the lens assembly 20.

The lens assembly 120 is then ground and polished to have desired ocularproperties and a substantially circular cross-section through a planeperpendicular to the optical axis 140.

Referring now to FIGS. 21-23, another embodiment of a contact lensassembly is provided. The embodiment of FIGS. 21-23 is substantiallysimilar to the embodiment of FIGS. 8-14 in design and manufacture,except that reflecting surfaces 350 and 352 are moved outbound toprovide a wider central view (straight down through the lens body 322without using a mirror) to provide an enhanced view of an instrumentmoving from the point of incision I to the anterior chamber angle A.

Embodiments of handle assemblies for one-handed operation will now bedescribed in greater detail with reference to FIGS. 24A-36. Such handleassemblies can be used in combination with the lenses described above.

Turning now to FIGS. 24A-24B, there is shown one example of a lenshandle, generally designated 420, formed in accordance with aspects ofthe present disclosure. The lens handle 420 is suitable for use duringmedical procedures of the eye, such as for example, the treatment ofglaucoma or the like. Generally described, the lens handle 420 includesa lens assembly 424 carried by or otherwise associated with a handle428. As will be described in more detail below, the lens handle 420 isconfigured for one-handed operation, including a user manipulatableactuator 430 (see FIG. 24B) that affects movement of the lens assembly424 with respect to the handle 428. In use, the lens handle 420 can begrasped with one hand of the user while the other hand of the user isfree to hold another instrument associated with the particular medicalprocedure. While the lens handle 420 is in the hand of the user, thelens assembly 424 can be manipulated firstly by movement of the handle428 via the user's wrist or arm, and secondly, by actuation of theactuator 430 with the user's finger or fingers of the hand grasping thehandle 428.

Referring to FIGS. 24A-30, the components of the lens handle 420 will bedescribed in more detail. As shown in FIGS. 24A, 24B, 25, and 30, thelens assembly 424 is carried at the end of the handle 428. In thatregard, the handle 428 includes an elongate body 432 to which a lensassembly retainer 434 is formed, attached, or otherwise provided at thedistal end thereof. In the embodiment shown in FIGS. 24A and 30, thelens assembly retainer 434 is in the form of a ring defining acylindrical bore 436 (FIG. 30), and having walls 438 with a generallyrectangular cross section and a top chamfered edge. The lens assemblyretainer 434 is disposed at an angle α with respect to the longitudinalaxis of the handle 428, as shown in FIG. 30. In some embodiments, theangle α is approximately between 30 and 40 degrees or greater, and inone embodiment, is approximately 35 degrees. In other embodiments, theangle α is approximately between 0-15 degrees or greater for use with,for example, slit lamp lenses. As such, one or more embodiments mayemploy an angle α approximately between 0-50 degrees. As will bedescribed in more detail below, the lens assembly retainer 434 is sizedand configured to interface with the lens assembly 424 for releasablesecurement therewith. Once coupled, the lens assembly 424 is allowed torotate about the axis 440 of the bore 436.

Referring now to FIG. 25, the lens assembly 424 in some embodimentsincludes a collar-like lens housing 442 (“lens housing 442”) thatsurrounds a lens 444. The lens 444 can be any suitable “on-axis” styleviewing lens (e.g., an unreversed viewing lens described above).

At its distal end, the lens housing 442 includes a lens retaininginterface 450 configured to retain or hold the lens 444 in positionduring use. In some embodiments, the lens retaining interface 450 is inthe form of a collet having a plurality of annularly disposed legs 456separated by kerfs or slots 458, as shown in in FIGS. 26, 27, and 29.The collet defines a generally cylindrical, inner cavity 462 forreceiving at least a portion of the lens 444 therein. As shown in FIG.29, the outer, free ends of the legs 456 can be slanted generallyinwardly in some embodiments, each forming an engagement flange segment464. Together, the engagement flange segments 464 define the distalopening 468 (see FIG. 27) of the lens housing 442, which communicateswith the inner cavity 462.

In some embodiments, the legs 456 are configured and arranged toslightly flex outwardly during installation of the lens 444. As aresult, the engagement flange segments 464 of the slightly flexed legs456 apply pressure to the outer surface of the lens 444. This pressure,along with frictional forces between the lens 444 and the inner walls ofthe housing 442, releasably retain or hold the lens 444. In theembodiment shown in FIGS. 24A and 24B, a portion of the lens 444 extendsoutwardly of the distal end of the lens housing 442 once retained by thecollet of the lens housing 442. It will be appreciated that the lens 444can be any type of lens useful in one or more surgical procedures,including but not limited to a direct viewing lens, a mirrored lens, anunreversed viewing lens, etc.

Returning to FIGS. 26, 27, and 29, the lens housing 442 also includes anannular flange 476 spaced proximally of the lens retaining interface 450(e.g., collet, etc.). The annular flange 476 extends radially outwardlyof the housing 442, and in some embodiments, has a somewhat truncated,right triangular-like cross section (FIG. 29). In that regard, theflange 476 defines a proximal facing surface 480 positioned orthogonalto the longitudinal axis of the housing 442 and a slanted surface 482.Extending from the slanted surface 482 of the flange 476 are a plural ofgear teeth 486, thereby forming a ring gear 488 (see FIGS. 26 and 27).In the embodiment shown, the ends of the teeth 486 of the ring gear 488are generally rounded and extend at an angle with respect to thelongitudinal axis of the housing 442 (see FIG. 29). In some embodiments,the angle β is approximately between 30-40 degrees, and in oneembodiment, is approximately 35 degrees. In these and other embodiments,the angle is approximately equal to the angle α.

The lens housing 442 further includes a handle coupling interface 494disposed at its proximal end, opposite the lens retaining interface 450.The handle coupling interface 494 is configured to couple the lenshousing 442 with the lens assembly retainer 434 of the handle 428. Insome embodiments, the handle coupling interface 494 is configured toreleasably couple the lens housing 442 to the handle 428.

In the embodiment shown in FIGS. 26, 27, and 29, the handle couplinginterface 494 includes a pair of opposing snap retainers 496 extendingin the proximal direction from the outer annular walls of a proximalsection of the lens housing 442. The snap retainers 496 include radiallyoutwardly extending flange sections 498, the bottoms of which form anannular channel 500 with the proximal facing surface 480 of the annularring 476. The snap extensions 496 are configured and arranged toslightly flex inwardly during coupling of the lens assembly 424 to thehandle 428. In that regard, the flange segments 498 snap back (with thesnap extensions) after they pass through the bore 436 of the lensassembly retainer 434, causing the lens assembly retainer 434 to bedisposed in the channel 500 and surrounding the lens housing 442, andthus, coupling the lens assembly 424 to the handle 428. Once coupled,the lens assembly 424 is allowed to rotate with respect to the handle428 about the longitudinal axis 440 of the bore 436. In use, thelongitudinal axis 440 is generally aligned with the optical axis of thepatient's eye.

In some embodiments, the lens housing 442 includes an optional, innerannular flange 502 positioned somewhat in the proximal cavity. The innerannular flange 502 in some embodiments may be used as an end stop forinsertion of the lens 444.

Returning now to FIGS. 24A, 24B, and 30, the actuator 430 is carried bythe body 432, and is configured and arranged to interface with the lensassembly 424 in order to manipulate the lens assembly 424. In theembodiment shown in FIG. 30, the actuator 430 includes a drive shaft 504journaled for rotation about an axis parallel with the longitudinal axisof the handle 428. At the distal end of the drive shaft 504 there isformed, attached or otherwise provided a drive gear 508. The drive gear508 includes a plurality of teeth 512 configured and arranged tocooperate with the teeth 486 of the ring gear 488 such that rotation ofthe drive shaft 504 results in rotation of the lens assembly 424. Alongthe length of the body, the drive shaft 504 can include a lever in theform of a knob or can be formed with a splined or knurled section tointerface with a finger or fingers of the user. In that regard, thehandle body 432 may include a recess 446 or the like to provide accessto the drive shaft 504 in order for the user's finger to contact androtate the drive shaft 504. Access to the drive shaft 504 is positionedin an ergonomic location such that the user (e.g., surgeon) can hold thehandle 428 and rotate the drive shaft in a one handed operation. Thehandle body 432 in some embodiments may be ergonomically configured forcomfort when gripped by the doctor and can include one or more knurledsurface sections.

Additionally or alternatively, the drive shaft 504 may include anenlarged knob 506 formed, affixed, mounted, or otherwise disposed at theproximal end thereof. In several embodiments of the present disclosure,the knob 506 provides an alternative or additional lever suitable foruse by the doctor in order to rotate the drive shaft 504.

FIGS. 31A and 31B illustrate another embodiment of a lens handle 520 inaccordance with aspects of the present disclosure. The lens handle 520is substantially identical to lens handle 420 described above withreference to FIGS. 24A-30 except for the differences that will now bedescribed. In that regard, attention is directed to FIGS. 31A-36, whichillustrates one example of a lens handle 520 in which the actuator 530is driven by a drive motor 552. As best shown in FIGS. 31B and 32, thedrive motor 552 is mounted to the proximal end of the handle body 532via mounting bracket 554 or other suitable structure. The drive motor552 includes an output shaft 590 that is configured to interface (e.g.,keyed, splined, pinned, etc.) with the knob 606 of the drive shaft 604for effecting co-rotation therebetween. While the output shaft 590 isoriented coaxially with the drive shaft 604, other configurations arepossible. For example, in some embodiments, the output shaft 590 can beoffset with the drive shaft 604 or can be disposed orthogonal thereto,etc.

Drive signals for operating the drive motor 552 with either continuousor incremental rotation can be supplied via activation of a switch 594.The switch 594 can be mounted on the handle 528 or remote therefrom,such as a foot switch, table mounted switch, etc. As such, activation ofthe switch 594, such as by movement, delivers device specific controlsignals to be carried out by the drive motor 552. In some embodiments,the drive motor 552 can include but is not limited to AC or DC electricmotor, a stepper motor, a servo motor, etc.

In one embodiment, the drive motor 552 includes a stepper motor thatreceives signal pulses from a controller 596, such as a microcontroller,via operation of the switch 594. The stepper motor can beservo-controlled, depending on its intended application. In response tothe signal pulses, the stepper motor rotates the output shaft 590clockwise/counterclockwise, in increments or “steps” of full shaftrotation. In turn, the output shaft 590 drives the drive shaft 204 inorder to rotate the lens assembly 524 from 0-90 degrees in someembodiments (e.g., using a 4-mirrored lens, etc.), and between 0-360degrees in other embodiments.

The lens handle 520 also employs another example of a lens housing,generally designated 542. The lens housing 542 can also be employed withthe handle 28 described above. In that regard, various configurations ofthe lens housing may be employed with the lens handles 420, 520depending on its intended application (e.g., which lens is preferred bythe doctor for a given ophthalmological procedure). In that regard, anylens housing that either permanently or selectively retains a lens whilealso providing a suitable interface with the actuator may be practicedwith embodiments of the present disclosure.

As shown in FIGS. 34-36, the lens housing 542 is configured for usewith, for example, a prism lens 544 (see FIG. 34). In that regard, thelens housing 542 is generally collar shaped for retaining the lens 544.The lens housing 542 includes a handle coupling interface 594 configuredto couple the lens housing 542 to the lens assembly retainer 534 of thehandle 528. In some embodiments, the handle coupling interface 594 isconfigured to releasably couple the lens housing 542 to the handle 528.

At its distal end, the lens housing 542 includes a lens retaininginterface 550 configured to retain or hold the lens 544 in positionduring use. In some embodiments, the lens retaining interface 550 formsof an internal shoulder 610 formed by a distal opening 568 of smallercross section than the interior cavity 562 of the main body of the lenshousing 542. The shoulder 610 and opening 568 cooperatively receive thelens 544 when assembled, as shown in FIG. 35.

While one example of a gear arrangement has be illustrated anddescribed, it will be appreciated that other rotary to rotary mechanismsmay be employed in embodiments of the lens handle 420, 520.Additionally, other actuators that provide rotation to the lens assemblymay be practiced with embodiments of the present disclosure. Forexample, actuators employing reciprocating to rotary mechanisms, etc.,to rotate the lens assembly 424, 524 may be used.

It should be noted that for purposes of this disclosure, terminologysuch as “upper,” “lower,” “vertical,” “horizontal,” “fore,” “aft,”“inner,” “outer,” “inwardly,” “outwardly,” “proximal”, “distal,”“front,” “rear,” etc., should be construed as descriptive and notlimiting the scope of the claimed subject matter. Further, the use of“including,” “comprising,” or “having” and variations thereof herein ismeant to encompass the items listed thereafter and equivalents thereofas well as additional items. Unless limited otherwise, the terms“connected,” “coupled,” and “mounted” and variations thereof herein areused broadly and encompass direct and indirect connections, couplings,and mountings.

While illustrative embodiments have been illustrated and described, itwill be appreciated that various changes can be made therein withoutdeparting from the spirit and scope of the disclosure.

1. A double-reflecting contact lens assembly for viewing the anteriorchamber of an eye, the lens assembly comprising: (a) a lens body havinga contact end defining at least a portion of first surface and a viewingend defining at least a portion of a second surface, wherein the lensbody is a prism having an optical axis and magnification in the range ofgreater than 1× to about 2×; (b) a first reflecting surface disposedadjacent the lens body; and (c) a second reflecting surface disposedadjacent the lens body opposing the first reflecting surface.
 2. Thelens assembly of claim 1, wherein the at least a portion of the firstsurface is contoured to conform to the surface of an eye.
 3. The lensassembly of claim 1, wherein the first surface has a contact diameter ofless than 11 mm.
 4. The lens assembly of claim 1, wherein the firstsurface has a contact diameter of less than 10 mm.
 5. The lens assemblyof claim 1, wherein the viewing end is angled relative to the opticalaxis.
 6. (canceled)
 7. The lens assembly of claim 1, wherein the firstreflecting surface is angled relative to the optical axis, the anglebeing in the range of about 22 degrees to about 38 degrees.
 8. The lensassembly of claim 1, wherein the second reflecting surface is angledrelative to the optical axis, the angle being in the range of +/−10degrees.
 9. The lens assembly of claim 1, wherein the first reflectingsurface intersects the contact and viewing ends of the lens body. 10.The lens assembly of claim 1, wherein the first reflecting surfaceintersects only the viewing end of the lens body.
 11. The lens assemblyof claim 1, wherein the second reflecting surface intersects the contactand viewing ends of the lens body.
 12. The lens assembly of claim 1,wherein the first reflecting surface is substantially planar.
 13. Thelens assembly of claim 1, wherein the second reflecting surface issubstantially planar.
 14. The lens assembly of claim 1, furthercomprising a first outer portion adjacent the first reflecting surfacehaving a contact end defining at least a portion of the first surfaceand a viewing end defining at least a portion of the second surface. 15.The lens assembly of claim 1, further comprising a first outer portionadjacent the first reflecting surface having a viewing end defining atleast a portion of the second surface.
 16. The lens assembly of claim15, further comprising a second outer portion adjacent the secondreflecting surface having a contact end defining at least a portion ofthe first surface and a viewing end defining at least a portion of thesecond surface.
 17. The lens assembly of claim 16, wherein the lens bodyand the first and second outer portions define a lens assembly having asubstantially circular cross-section though a plane perpendicular to theoptical axis.
 18. The lens assembly of claim 1, further including abeveled edge at the first surface.
 19. The lens assembly of claim 1,further including a cut-out portion in the first surface.
 20. The lensassembly of claim 1, wherein the lens assembly does not include an outerprotective coating.
 21. A double-reflecting contact lens assembly forviewing the anterior chamber of an eye, the lens assembly comprising:(a) a lens body having a contact end defining at least a portion of aneye contact surface and a viewing end defining at least a portion of aviewing surface, wherein the lens body is a prism having an optical axisand magnification in the range of greater than 1× to about 1.5×; (b) afirst reflecting surface disposed adjacent the lens body, wherein thefirst reflecting surface is substantially planar and intersects theviewing end of the lens body; (c) a second reflecting surface disposedadjacent the lens body opposing the first reflecting surface, whereinthe second reflecting surface is substantially planar and intersects thecontact and viewing ends of the lens body; (d) a first outer portionadjacent the first reflecting surface having a contact end defining atleast a portion of the eye contact surface and a viewing end defining atleast a portion of the viewing surface; and (e) a second outer portionadjacent the second reflecting surface having a contact end defining atleast a portion of the eye contact surface and a viewing end defining atleast a portion of the viewing surface, wherein the lens body and thefirst and second outer portions define a lens assembly having asubstantially circular cross-section though a plane perpendicular to theoptical axis. 22-35. (canceled)